Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
  • A61K38/1709—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/18—Growth factors; Growth regulators
  • A61K38/1891—Angiogenesic factors; Angiogenin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/475—Growth factors; Growth regulators
  • C07K14/515—Angiogenesic factors; Angiogenin

Definitions

• the disclosure relates to methods, treatment regimens, uses, kits and therapies for treating osteoarthritis by administering a therapeutic polypeptide according to the dosing regimens disclosed herein.
• Osteoarthritis a slowly progressive disease with a multifactorial pathophysiology, is one of the most common chronic health conditions in adults, and a leading cause of pain and disability (OARSI 2016, submitted to the U.S. Food and Drug Administration, viewed 16 December 2019, p. 1-103). Due to the demographic changes in an ageing society and an increase in the incidence of obesity, the prevalence of OA will steadily increase, posing a significant burden on global health-care systems. (OARSI 2016; Fu & Griffin 2014, Biomaterials, vol 16. Springer, Ch). On the individual level OA leads to suffering with OA symptoms being responsible for 6.8% of overall DALYs (disability adjusted life years). (Cross et al 2014, Ann. Rheum. Dis.
• the knee joint is the most common weight bearing joint affected by OA.
• Current medical treatments of OA focus on addressing pain, but there are no disease-modifying OA drugs (DMO ADs), e.g., chondro-anabolic treatments, available to induce cartilage regeneration.
• DMO ADs disease-modifying OA drugs
• Eventual joint failure requiring surgical joint replacement is common, with over a million such operations annually in the United States (Williams et al 2015, NCHS Data Brief p. 1-8; Wolford et al 2015, NCHS Data Brief p. 1- 8).
• not all patients are satisfied with the result, or benefit from joint replacement surgery.
• the present invention provides methods for treating osteoarthritis (e.g., knee osteoarthritis) by administering therapeutically effective amounts of a modified human ANGPTL3 polypeptide, i.e., Compound 1, to the joint (e g., knee) of a human subject according to the dosing regimens disclosed herein.
• a modified human ANGPTL3 polypeptide i.e., Compound 1
• the inventors have surprisingly discovered that administering Compound 1 according to the presently described dosing regimens results in a therapeutically beneficial effect for a human subject despite administering fewer injections on a less frequent basis than what has been previously described.
• the present invention provides for a method of treating osteoarthritis comprising administering to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the dosing cycle is a six-month dosing cycle comprising one intra-articular injection.
• the dosing cycle is a six-month dosing cycle comprising three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two six-month dosing cycles, four six-month dosing cycles, or eight six-month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection per dosing cycle or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• the present invention provides for a method of treating osteoarthritis comprising administering to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more twelve-month dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the twelve- month dosing cycle comprises one intra-articular injection.
• the twelve- month dosing cycle comprises three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two twelve-month dosing cycles, or four twelve-month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• treatment according to one of the described dosing regimens results in an increase in cartilage thickness compared to placebo as determined by quantitative magnetic resonance imaging. In other embodiments, the increase in cartilage thickness is in the targeted knee joint. In some embodiments, treatment according to one of the described dosing regimens results in a decrease in osteoarthritis pain in the target knee joint compared to placebo as determined by WOMAC pain and WOMAC pain walking on flat surface item. In other embodiments, treatment according to one of the described dosing regimens results in an increase in physical function in the target knee joint compared to placebo as determined by WOMAC function.
• treatment according to one of the described dosing regimens results in an increase in performance-based physical function in the target knee joint compared to placebo as determined by a 40-meter (4 x 10m) fast-paced walk test, 30-second chair stand test, and 6-minute walking test.
• treatment according to one of the described dosing regimens results in an increase in structural progression of the target knee joint compared to placebo as determined by qMRI and x-ray.
• the present invention provides Compound 1 for use in the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the kneejomt.
• the dosing cycle is a six- month dosing cycle comprising one intra-articular injection.
• the dosing cycle is a six-month dosing cycle comprising three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two six-month dosing cycles, four six-month dosing cycles, or eight six-month dosing cycles, wherein each dosing cycle may comprise one intra- articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• the present invention provides Compound 1 for use in the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more twelve-month dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the twelve-month dosing cycle comprises one intra-articular injection.
• the twelve- month dosing cycle comprises three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two twelve-month dosing cycles, or four twelve- month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• Compound 1 for use according to one of the described dosing regimens results in an increase in cartilage thickness compared to placebo as determined by quantitative magnetic resonance imaging. In other embodiments, the increase in cartilage thickness is in the targeted knee joint. In some embodiments, Compound 1 for use according to one of the described dosing regimens results in a decrease in osteoarthritis pain in the target knee joint compared to placebo as determined by WOMAC pain and WOMAC pain walking on flat surface item. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in physical function in the target knee joint compared to placebo as determined by WOMAC function.
• Compound 1 for use according to one of the described dosing regimens results in an increase in performance-based physical function in the target knee joint compared to placebo as determined by a 40-meter (4 x 10m) fast-paced walk test, 30-second chair stand test, and 6-minute walking test. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in structural progression of the target knee joint compared to placebo as determined by qMRI and x-ray.
• the present invention provides Compound 1 for use in the manufacture of a medicament for the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by mtra-articular injection to a joint of the subject according to a dosing regimen comprising one or more dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the dosing cycle is a six-month dosing cycle comprising one intra-articular injection.
• the dosing cycle is a six- month dosing cycle comprising three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two six-month dosing cycles, four six-month dosing cycles, or eight six-month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• the present invention provides Compound 1 for use in the manufacture of a medicament for the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more twelve-month dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the twelve- month comprises one intra- articular injection.
• the twelve-month dosing cycle comprises three mtra- articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two twelve-month dosing cycles, or four twelve-month dosing cycles, wherein each dosing cycle may comprise one mtra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• Compound 1 for use in the manufacture of a medicament for the treatment of osteoarthritis when administered to a human subject in need thereof according to one of the described dosing regimens results in an increase in cartilage thickness compared to placebo as determined by quantitative magnetic resonance imaging. In other embodiments, the increase in cartilage thickness is in the targeted knee joint. In some embodiments, Compound 1 for use according to one of the described dosing regimens results in a decrease in osteoarthritis pain in the target knee joint compared to placebo as determined by WOMAC pain and WOMAC pain walking on flat surface item. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in physical function in the target knee joint compared to placebo as determined by WOMAC function.
• Compound 1 for use according to one of the described dosing regimens results in an increase in performance-based physical function in the target knee joint compared to placebo as determined by a 40-meter (4 x 10m) fast-paced walk test, 30-second chair stand test, and 6-minute walking test. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in structural progression of the target knee joint compared to placebo as determined by qMRI and x-ray.
• the present invention provides a pharmaceutical composition comprising Compound 1 for use in the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by mtra-articular injection to a joint of the subject according to a dosing regimen comprising one or more dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the dosing cycle is a six-month dosing cycle comprising one mtra-articular injection.
• the dosing cycle is a six- month dosing cycle comprising three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two six-month dosing cycles, four six-month dosing cycles, or eight six-month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• the present invention provides a pharmaceutical composition comprising Compound 1 for use in the treatment of osteoarthritis via administration to a human subject in need thereof one or more doses of a therapeutically effective amount of Compound 1 by intra-articular injection to a joint of the subject according to a dosing regimen comprising one or more twelve-month dosing cycles.
• the osteoarthritis is knee osteoarthritis and the joint is the knee joint.
• the twelve-month dosing cycle comprises one intra-articular injection.
• the twelve-month dosing cycle comprises three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the dosing regimen comprises two twelve- month dosing cycles, or four twelve-month dosing cycles, wherein each dosing cycle may comprise one intra-articular injection or three intra-articular injections per dosing cycle with one injection administered once a month for three consecutive months.
• the therapeutically effective amount of Compound 1 administered per injection is 20 mg. In other embodiments, the therapeutically effective amount of Compound 1 administered per injection is 40 mg.
• a pharmaceutical composition comprising Compound 1 for use in the treatment of osteoarthritis when administered to a human subject in need thereof according to one of the described dosing regimens results in an increase in cartilage thickness compared to placebo as determined by quantitative magnetic resonance imaging. In other embodiments, the increase in cartilage thickness is in the targeted knee joint. In some embodiments, Compound 1 for use according to one of the described dosing regimens results in a decrease in osteoarthritis pain in the target knee joint compared to placebo as determined by WOMAC pain and WOMAC pain walking on flat surface item. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in physical function in the target knee joint compared to placebo as determined by WOMAC function.
• Compound 1 for use according to one of the described dosing regimens results in an increase in performance- based physical function in the target knee joint compared to placebo as determined by a 40-meter (4 x 10m) fast-paced walk test, 30-second chair stand test, and 6-minute walking test. In other embodiments, Compound 1 for use according to one of the described dosing regimens results in an increase in structural progression of the target knee joint compared to placebo as determined by qMRI and x-ray.
• FIG. 1 is a schematic representation of exemplary dosing regimens.
• CMPD1 Compound 1.
• Figure 2 depicts immunohistochemical staining of osteochondral knee tissue obtained during a total knee replacement demonstrating that Compound 1 has a more pronounced penetration in (A) damaged cartilage tissue versus (B) undamaged cartilage tissue.
• Figure 3 depicts RNA-Seq analysis of cartilage biopsies harvested from worn and unworn areas of the knee demonstrates that following intra-articular injection of Compound 1: A) 151 genes were significantly up- or down-regulated in response to Compound 1 as compared to placebo, and B) several genes involved in cartilage homeostasis and repair are modulated by Compound 1 up to 21 days post-injection.
• CMPD1 Compound 1.
• Figure 4 A) a cartilage 3D MRI rendering showing administration of a single intra-articular injection of Compound 1 to an exemplary patient undergoing autologous chondrocyte implantation resulted in an increased filling of a surgically created lesion at the donor site as compared to placebo.
• B) is a graphical representation demonstrating that percent refilling of the donor site is increased over time in an exemplary patient administered a single intra-articular injection of Compound 1 as compared to placebo.
• CMPD1 Compound 1.
• Figure 5 A) Sodium-MRI images confirming the hyaline-like cartilage nature of regenerated tissue at the donor site of an exemplary patient undergoing autologous chondrocyte implantation that was administered a single intra-articular injection of Compound 1 at 2 time points as compared to placebo. B) demonstrates that the treatment response calculated as percent change from baseline in sodium signal intensity in the donor site corrected by sodium signal intensity in the reference region of an exemplary patient administered Compound 1 increases over time as compared to placebo.
• CMPD1 Compound 1.
• Figure 6 depicts 3D MRI images from an exemplary patient treated with four weekly intra- articular injections of Compound 1 demonstrating successful articular cartilage lesion filling.
• CMPD1 Compound 1.
• Figure 7 depicts the model estimated percentage difference of Compound 1 to placebo in cartilage defect volume over time (PD analysis set) in patients with partial thickness lesions demonstrating that Compound 1 decreases the cartilage defect volume.
• MMRM mixed model repeated measures;
• CMPD1 Compound 1.
• Modified human ANGPTL3 polypeptides have been shown to demonstrate chondrogenic and chondroprotective effects. Examples of such polypeptides have been previously described in WO2014/138687, the contents of which are fully incorporated by reference. Methods of administering such polypeptides for the purpose of treating cartilage damage and/or arthritis have been previously described in WO2018/087727.
• Prior art methods of administering Compound 1, e.g., those described in WO2018/087727 contemplate frequent intra-articular injections (e.g., g weekly) and do not describe defined dosing and resting periods. Instead, the prior art methods contemplate continuing the administration of Compound 1 until such time as the condition, e.g., cartilage damage or arthritis, is treated.
• subject refers to an animal, human or non-human, to whom treatment according to the methods of the present invention is provided.
• Veterinary and non-veterinary applications are contemplated.
• the term includes, but is not limited to, mammals, e.g., humans, other primates, pigs, rodents such as mice and rats, rabbits, guinea pigs, hamsters, cows, horses, cats, dogs, sheep and goats.
• Typical subjects include humans, farm animals, and domestic pets such as cats and dogs.
• treatment is herein defined as both therapeutic treatment and prophylactic or preventive measures, wherein the object is to prevent or slow down an undesired physiological change or disorder.
• beneficial or desired clinical results include, but are not limited to, alleviation of symptoms, diminishment of extent of disease, stabilized (i.e., not worsening) state of disease, delay or slowing of disease progression, amelioration or palliation of the disease state, and reversal (whether partial or total), whether detectable or undetectable.
• a subject is “in need of’ a treatment if such subject would benefit biologically, medically or in quality of life from such treatment.
• pharmaceutically acceptable refers to those compounds, materials, compositions and/or dosage forms, which are, within the scope of sound medical judgment, suitable for contact with the tissues of a subject, e.g., a mammal or human, without excessive toxicity, irritation, allergic response and other problems or complications commensurate with a reasonable benefit/risk ratio.
• administration means providing a drug, a modified derivative of a drug, or a prodrug to a subject in need of treatment.
• dosing regimen refers to the treatment plan specifically indicating the administration pattern of a drug over a period of time.
• the dosing regimen defines the amount of a drug and the number and frequency of its administrations that is employed in the treatment of a disease.
• the dosing regimens of the present invention may comprise one or more dosing cycles.
• dosing cycle means administering a drug for a period of time (i.e., the dosing period) followed by a resting period before administration of the drug is resumed.
• a dosing cycle begins with the first administration of the drug in that cycle.
• resting period refers to a period of time during which the subject is not given a drug (i.e., a period of time wherein the treatment with a drug is withheld). For example, if a drug is given on a daily, weekly, or monthly basis, there would be rest period if the administration is discontinued for some time, e.g., for some number of days, weeks, or months.
• the dosing period and/or the resting period of the dosing cycle can be the same or different between cycles. For example, if the dosing period is once weekly the resting period may be one week or more than one week. It is contemplated that the dose of the drug administered can be the same or different between cycles.
• dose refers to a specified amount of a drug administered at one time. As used herein, the dose is the amount of the drug that elicits a therapeutic effect.
• a therapeutically effective amount of a drug refers to an amount of a drug that will elicit the desired biological or medical response in a subject, for example, at least partially ameliorate symptoms, alleviate conditions, slow or delay progression, or reverse a disorder or disease.
• “About” and “approximately” shall generally mean an acceptable degree of error for the quantity measured given the nature or precision of the measurements. Exemplary degrees of error are within 20 percent (%), typically, within 10%, and more typically, within 5% of a given value or range of values.
• the actual dosage can vary by up to 10% from the stated amount: this usage of “about” recognizes that the precise amount in a given dosage form may differ slightly from an intended amount for various reasons without materially affecting the in vivo effect of the administered compound.
• the actual dosage can vary by up to 10% (preferably by up to 5%) from the stated amount: this usage recognizes that the precise amount in a given dosage form may differ slightly from an intended amount for various reasons without materially affecting the in vivo effect of the administered compound.
• a therapeutic agent in these combinations can be administered concurrently with, prior to, or subsequent to, one or more other additional therapies or therapeutic agents.
• the therapeutic agents can be administered in any order. In general, each agent will be administered at a dose and/or on a time schedule determined for that agent. It will further be appreciated that the additional therapeutic agent utilized in this combination may be administered together in a single composition or administered separately in different compositions. In general, it is expected that additional therapeutic agents utilized in combination be utilized at levels that do not exceed the levels at which they are utilized individually.
• the levels utilized in combination will be lower than those utilized as single-agent therapeutics.
• the combinations of the invention have therapeutic or protective functions or both.
• these molecules may be administered to a human subject, to treat and/or prevent a variety of disorders, such as OA as described herein.
• combination refers to either a fixed combination in one dosage unit form, or non-fixed combination, or a kit of parts for the combined administration where two or more therapeutic agents may be administered together, independently at the same time or separately within time intervals, especially where these time intervals allow that the combination partners show a cooperative, e.g., synergistic, effect.
• combination therapy refers to the administration of two or more therapeutic agents to treat a therapeutic condition or disorder described in the present disclosure.
• administration encompasses co-administration of these therapeutic agents in a substantially simultaneous manner, such as in a single formulation having a fixed ratio of active ingredients or in separate formulations (e.g, different i.a. formulations, or formulations for different routes of administration) for each active ingredient.
• administration also encompasses use of each type of therapeutic agent in a sequential or separate manner, either at approximately the same time or at different times.
• the active ingredients are administered as a single formulation or in separate formulations
• the drugs are administered to the same patient as part of the same course of therapy.
• the treatment regimen will provide beneficial effects in treating the conditions or disorders described herein.
• simultaneous therapeutic use within the meaning of the present invention is meant an administration of at least two active ingredients by the same route and at the same time or at substantially the same time.
• sequential therapeutic use is meant administration of at least two active ingredients at different times, the administration route being identical or different. More particularly by an administration method is meant according to which the whole administration of one of the active ingredients is carried out before administration of the other or others commences.
• fixed combination refers to a single carrier or vehicle or dosage form formulated to deliver an amount, which is jointly therapeutically effective for the treatment of OA, of both therapeutic agents to a patient.
• the single vehicle is designed to deliver an amount of each of the agents along with any pharmaceutically acceptable carriers or excipients.
• the vehicle is a solution or a suspension.
• non-fixed combination or “kit of parts” means that the therapeutic agents of the combination of the invention are both administered to a patient as separate entities either simultaneously, concurrently or sequentially with no specific time limits, wherein such administration provides therapeutically effective levels of the two compounds in the body of a subject in need thereof.
• Compound 1 Demonstrates Therapeutic Efficacy
• Compound 1 is a modified ANGPTL3 polypeptide that has been shown to demonstrate chondrogenic and chondroprotective effects.
• Compound 1 has been previously described in WO2014/138687, the contents of which are fully incorporated by reference. Without wishing to be bound by theory, it is believed that Compound 1 acts directly on cartilage resident-mesenchymal stromal cells (CR-MSCs) and articular chondrocytes through binding to a5b1 and anb3 integrms to transmit its anabolic repair effects on cartilage cells, promoting the formation of articular cartilage extracellular matrix proteins in mature chondrocytes and in CR-MSCs.
• the amino acid sequence of Compound 1 is set forth below in Table 1.
• the Compound 1 administered according to the described dosing regimens is unmodified.
• the Compound 1 is PEGylated.
• the Compound 1 is fused to a heterologous peptide.
• the Compound 1 is fused to any one of human serum albumin (HSA), an immunoglobulin heavy chain constant region (Fc), a polyhistidine, a glutathione S transferase (GST), a thioredoxin, a protein A, a protein G, a maltose binding protein (MBP), or a fragment of any of the foregoing heterologous polypeptide(s).
• HSA human serum albumin
• Fc immunoglobulin heavy chain constant region
• GST glutathione S transferase
• MBP maltose binding protein
• the heterologous polypeptide is fused at the amino-terminal end of Compound 1.
• the heterologous polypeptide is fused at the carboxyl-terminal end of the Compound 1.
• the Compound 1 is delivered according to the drug delivery system described in US Publication Number 2020/0108153, the contents of which are fully incorporated by reference herein.
• Compound 1 has been shown to exhibit chondrogenic activity.
• FH first-in-human
• Compound 1 was evaluated in human patients with OA who were scheduled for total knee replacement (TKR).
• TRR total knee replacement
• PK pharmacokinetics
• IG immunogenicity
• a proof of mechanism (PoM) study was subsequently performed in participants undergoing autologous chondrocyte implantation (ACI) to treat a focal cartilage lesion.
• ACI autologous chondrocyte implantation
• Those participants received a single injection of 20 mg Compound 1, and both the extent of tissue growth and the quality of tissue composition were evaluated with 7 Tesla MRI including sodium sequences.
• Results showed that tissue compatible with early hyaline cartilage was detected at the donor sites at 4 and 12 weeks post-Compound 1 dose. (FIG. 4, 5).
• Part A of a proof of concept (PoC) study has completed dosing and follow-up in participants with knee cartilage injury who received 4 weekly injections of 20 mg Compound 1 and were then followed up for 52 weeks. Results confirm the cartilage anabolic activity of Compound 1 in humans at 28 weeks follow up measured with 3T MRI. (FIG. 6, 7). Overall, at the interim analysis, the treatment was well-tolerated and no relevant systemic safety signal was reported.
• Part B of the PoC study m participants with mild-moderate knee OA, receiving 4 monthly injections of 20 mg or 40 mg Compound 1, is currently ongoing.
• the subject has arthritis, e.g., osteoarthritis, pre-arthritic trauma-associated changes, or autoimmune arthritis.
• the osteoarthritis is knee osteoarthritis.
• the subject has osteoarthritis with inflammation.
• the individual does not have, but is at risk for, arthritis with inflammation.
• treatment is expected to slow or halt the progress of OA and reduce or eliminate symptoms associated with osteoarthritis as compared to treatment with placebo.
• treatment may reduce pain as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, or other art recognized methods of gauging pain reduction.
• treatment may maintain or increase a patient’ s quality of life or activities of daily living as measured by the osteoarthritis knee and hip quality of life questionnaire (OAKHQOL), the WHO Quality of Life-BREF, Physical Activity Scale for the Elderly, or other art recognized methods.
• treatment may result in the maintenance or regeneration of articular cartilage, ligaments, or tendons as measured using quantitative MRI, qualitative MRI, histology of biopsies, inspection during arthroscopy, or other art recognized methods of ascertaining changes in joint tissue .
• treatment may result in the maintenance of joint structure based on cartilage volume as determined by quantitative MRI.
• treatment according to one of the presently described dosing regimens may improve or maintain (e.g., prevent further decrease) the function in the affected joint as assessed through WOMAC function, KOOS score, reduction in stiffness, or other art recognized methods of assessing physical function.
• increase in performance-based physical function can be assessed by a 40-meter (4 x 10m) fast-paced walk test, 30-second chair stand test, 6-minute walking test, gait analysis, activity measures, or other art recognized methods.
• treatment according to one of the presently described dosing regimens may prolong the survival of the joint affected with OA and/or increase the subject’s quality of life.
• treatment according to a dosage regimen of the present invention may prevent or delay the need for joint replacement surgery.
• treatment may be effective in reducing synovitis or bursitis.
• the therapeutic compounds may be administered according to any known administration method.
• the therapeutic compounds are administered via intra- articular administration.
• Other possible routes of administration include, e.g., intradermal, intramuscular, intravenous, and sub-cutaneous.
• the therapeutic compounds may also be administered according to any known means for administering a therapeutic to a patient, including, but not limited to, a pre-filled syringe, a vial and syringe, an injection pen, an autoinjector, an i.v. drip and bag, a pump, a patch pump, etc.
• a patient may self-administer the drug (i.e., administer the drug on their own behalf) or a physician may administer the drug.
• Compound 1 may be administered according to the dosage regimens described herein.
• the most effective dosages and dosage regimens for an individual subject may depend on the specific disease or condition to be treated and its severity.
• the dosing regimens may be continued or repeated until there is no longer a therapeutic benefit to the subject.
• the dosing regimen for Compound 1 may comprise one or more dosing cycles.
• Each dosing cycle may comprise one or more months, e.g., one month, two months, three months, four months, five months, six months, seven months, eight months, nine months, ten months, eleven months, or twelve months.
• a twelve month dosing cycle may also be referred to as a yearly dosing cycle.
• the dosing cycle is a six-month or twelve- month (yearly) dosing cycle.
• Each dosing cycle may comprise the administration of one or more, e.g., two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, or twenty-four, doses of Compound 1 during the dosing period.
• the doses may be administered during consecutive periods, e.g., consecutive days, weeks, or months.
• each dose may be administered once a week for four consecutive weeks, or once a month for four consecutive months.
• the two or more doses may be administered in alternating periods of time, e.g., every other day, week, or month.
• each dose may be administered every two weeks (bi-weekly) for two months.
• each dosing cycle comprises the same number of doses.
• each dosing cycle may comprise three administrations of Compound 1.
• the number of doses administered may vary from dosing cycle to dosing cycle within the same dosing regimen.
• dosing cycle 1 may comprise the administration of three doses of Compound 1 and dosing cycles 2 and 3 may comprise the administration of one dose of Compound 1.
• the resting period does not begin until the final dose of the dosing period has been administered.
• the doses could be administered m week one and week three, and the resting period could be week four.
• the resting period is of the same period of time as the dosing period. For example, if the dosing period is one month then the resting period is one month. In other embodiments, the resting period is of a different period of time than the dosing period. For example, if the dosing period is one month then the resting period may be one week or two months.
• the length of the dosing period and/or the length of the resting period may vary from dosing cycle to dosing cycle.
• dosing cycle 1 may comprise a three-month dosing period and a three-month resting period
• dosing cycle 2 may comprise a one-month dosing period and a five-month resting period.
• an Compound 1 dosing regimen comprises one or more six- month dosing cycles comprising one dose (i.e., a one-month dosing period) followed by a five- month resting period.
• the six-month dosing cycle comprises three doses administered once a month for three consecutive months (i.e., a three- month dosing period) followed by a three-month resting period.
• the Compound 1 dosing regimen comprises one or more twelve-month dosing cycles comprising one dose (i.e., a one-month dosing period) followed by an eleven-month resting period.
• a twelve-month dosing cycle comprises three doses administered once a month for three consecutive months (i.e., a three-month dosing period) followed by a nine-month resting period.
• an Compound 1 dosing regimen comprises at least four six-month dosing cycles, wherein each six-month dosing cycles comprises three doses of Compound 1 administered once a month for three consecutive months followed by a three-month rest period.
• an Compound 1 dosing regimen comprises at least eight six-month dosing cycles, wherein dosing cycles 1-4 (i.e., the first four dosing cycles) comprise three doses of Compound 1 administered once a month for three consecutive months followed by a three-month rest period, and dosing cycles 5-8 comprise one dose of Compound 1 followed by a five-month rest period.
• an Compound 1 dosing regimen comprises four six-month dosing cycles, wherein each six-month dosing cycles comprises one dose of Compound 1 followed by a five-month rest period. In another embodiment, an Compound 1 dosing regimen comprises at least eight six-month dosing cycles, wherein each six-month dosing cycle comprises one dose of Compound 1 followed by a five-month rest period.
• an Compound 1 dosing regimen comprises at least two twelve- month dosing cycles, wherein three doses are administered once a month for three consecutive months followed by a nine-month resting period.
• an Compound 1 dosing regimen comprises at least four twelve-month dosing cycles, wherein dosing cycles 1 and 2 comprise three doses are administered once a month for three consecutive months followed by a nine-month resting period, and dosing cycles 3 and 4 comprise one dose of Compound 1 followed by an eleven-month resting period.
• the dose of Compound 1 administered via intra-articular injection is about 10-100 mg, about 10-90 mg, about 10-80 mg, about 10-70 mg, about 10-60 mg, about 10-50 mg, about 10-40 mg, about 10-30 mg, about 10-20 mg, about 20-100 mg, about 20-90 mg, about 20-80 mg, about 20-70 mg, about 20-60 mg, about 20-50 mg, about 20-40 mg, about 20-30 mg, about 30-100 mg, about 30-90 mg, about 30-80 mg, about 30-70 mg, about 30-60 mg, about 30-50 mg, about 30-40 mg, about 40-100 mg, about 40-90 mg, about 40-80 mg, about 40-70 mg, about 40-60 mg, about 40-50 mg, about 50-100 mg, about 50-90 mg, about 50-80 mg, about 50- 70 mg, about 50-60 mg, about 60-100 mg, about 60-90 mg, about 60-80 mg, about 60-70 mg, about 70-100 mg, about 70-90 mg, about 70-80 mg, about 80-100 mg, about
• the dose of Compound 1 administered via intra-articular injection is about 10-55 mg, about 10-45 mg, about 10-35 mg, about 10-25 mg, about 10-15 mg, about 15-60 mg, about 15-55 mg, about 15-50 mg, about 15-45 mg, about 15-40 mg, about 15-35 mg, about 15-30 mg, about 15-25 mg, about 15-20 mg, about 20-55 mg, about 20-45 mg, about 20-35 mg, about 20-25 mg, about 25-60 mg, about 25-55 mg, about 25-50 mg, about 25-45 mg, about 25-40 mg, about 25-35 mg, about 25-30 mg, about 30-55 mg, about 30-45 mg, about 30-35 mg, about 35-60 mg, about 35-55 mg, about 35-50 mg, about 35-45 mg, about 35-40 mg, about 40-55 mg, about 40-45 mg, about 45-60 mg, about 45-55 mg, about 45-50 mg, about 50-55 mg, or about 55-60 mg.
• the dose of Compound 1 administered via intra-articular injection is about 5 mg, about 10 mg, about 15 mg, about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg, about 50 mg, about 55 mg, about 60 mg, about 65 mg, about 70 mg, about 75 mg, about 80 mg, about 85 mg, about 90 mg, about 95 mg, or about 100 mg.
• the dose of Compound 1 administered is 20-40 mg, 20 mg, or 40 mg.
• the dose of Compound 1 administered via intra-articular injection is 10-100 mg, 10-90 mg, 10-80 mg, 10-70 mg, 10-60 mg, 10-50 mg, 10-40 mg, 10-30 mg, 10-20 mg, 20-100 mg, 20-90 mg, 20-80 mg, 20-70 mg, 20-60 mg, 20-50 mg, 20-40 mg, 20-30 mg, 30- 100 mg, 30-90 mg, 30-80 mg, 30-70 mg, 30-60 mg, 30-50 mg, 30-40 mg, 40-100 mg, 40-90 mg, 40-80 mg, 40-70 mg, 40-60 mg, 40-50 mg, 50-100 mg, 50-90 mg, 50-80 mg, 50-70 mg, 50-60 mg, a 60-100 mg, 60-90 mg, 60-80 mg, 60-70 mg, 70-100 mg, 70-90 mg, 70-80 mg, 80-100 mg, 80-90 mg, or 90-100 mg.
• the dose of Compound 1 administered via intra-articular injection is 10-55 mg, 10-45 mg, 10-35 mg, 10-25 mg, 10-15 mg, 15-60 mg, 15-55 mg, 15-50 mg, 15-45 mg, 15-40 mg, 15-35 mg, 15-30 mg, 15-25 mg, 15-20 mg, 20-55 mg, 20-45 mg, 20-35 mg, 20-25 mg, 25-60 mg, 25-55 mg, 25-50 mg, 25-45 mg, 25-40 mg, 25-35 mg, 25-30 mg, 30-55 mg, 30-45 mg, 30-35 mg, 35-60 mg, 35-55 mg, 35-50 mg, 35-45 mg, 35-40 mg, 40-55 mg, 40-45 mg, 45- 60 mg, 45-55 mg, 45-50 mg, 50-55 mg, or 55-60 mg.
• the dose of Compound 1 administered via intra-articular injection is 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, or 100 mg.
• the dose of Compound 1 administered is 20-40 mg, 20 mg, or 40 mg.
• kits for treating a patient with OA are for treating a patient with knee OA. In other embodiments, the kits are for treating a patient with knee OA with inflammation.
• kits comprise Compound 1 (e.g., in liquid or lyophilized form) or a pharmaceutical composition comprising Compound land one or more pharmaceutically acceptable carriers. Additionally, such kits may comprise means for administering the Compound 1 (e.g., a syringe and vial, a prefilled syringe, a prefilled pen, a patch/pump) and instructions for use. The instructions may disclose providing the Compound 1 to the patient as part of a specific dosing regimen.
• phrases “means for administering” is used to indicate any available implement for systemically administering a drug to a patient, including, but not limited to, a pre- filled syringe, a vial and syringe, an injection pen, an autoinjector, an i.v. drip and bag, a pump, patch/pump, etc.
• a patient may self-administer the drug (i.e., administer the drug on their own behalf) or a care-giver or a physician may administer the drug.
• kits for the treatment of a patient having knee osteoarthritis with or without intra-articular inflammation comprising: (a) a pharmaceutical composition comprising a therapeutically effective amount of Compound 1 and one or more pharmaceutically acceptable carriers; (b) means for administering the Compound 1 ; and (c) instructions for the intra-articular administration of Compound 1.
• a use is provided, of (a) a pharmaceutical composition comprising Compound 1 and one or more pharmaceutically acceptable carriers, and (b) means for intra-articular administration of the Compound 1 to a patient having knee OA wherein the Compound 1 is to be administered intra-articularly to the patient with a dose of about 20 to 40 mg at four week (monthly) intervals according to a dosage regimen disclosed herein.
• Example 1 A Randomized, Placebo Controlled, Double-blind First-in- human Single
• a first-in-human, randomized, single-center, double-blind, placebo-controlled, single ascending dose trial was conducted in patients aged 50-75 years with knee OA scheduled for total knee replacement (TKR).
• Patients were randomized 3: 1 (Compound 1 to placebo) in each of 7 cohorts consisting of 4 patients each.
• the 5 increasing intra-articular dose levels ranging 0.2- 40 mg (0.2 mg, 2 mg, 10 mg, 20 mg, and 40 mg) were administered 7 days before TKR. Two additional 20 mg dose levels were also administered 2 hours or 21 days before TKR.
• Key safety parameters included AEs, injection-site reactions and detection of anti-drug antibodies against Compound 1.
• Knee tissues were obtained during the TKR procedure to assess local exposure to Compound 1 through immunohistochemical (IHC) staining, and RNA sequence (RNA-Seq) analysis was performed on cartilage tissue originating from visually damaged or undamaged areas of the joint surface that was removed intraoperatively.
• IHC immunohistochemical
• RNA-Seq RNA sequence analysis
• One drug-related case of dry mouth/dysgeusia was reported in the 40 mg cohort, which resolved spontaneously and was considered mild.
• RNA-Seq analysis demonstrated that 151 genes were significantly up- or down- regulated in damaged versus undamaged articular cartilage samples from placebo-treated OA patients (FIG. 3A). Compound 1 counter-regulated most of these OA-regulated genes in damaged cartilage 7 days post treatment, suggesting a broad effect of Compound 1 on genes involved in OA pathogenesis. RNA-Seq analysis further demonstrated modulation of several genes involved in cartilage homeostasis and repair, suggesting a broad effect by Compound 1 up to 21 days post- injection (FIG. 3B). These effects were both dose-dependent and mostly present in the damaged cartilage tissue.
• Compound 1 displayed a favorable safety profile without any clinically significant drug-related safety signals or immunogenicity. Compound 1 further showed a tendency to preferentially penetrate into damaged cartilage; was quickly cleared locally and systemically; and counter-regulated several cartilage genes involved in OA pathogenesis at the RNA level.
• Example 2 A Randomized, Placebo-controlled, Patient and Investigator Blinded, Single Dose, Proof of Concept Study Investigating the Safety, Tolerability and Preliminary Efficacy of Intra-articular Compound 1 in Regenerating the Articular Cartilage of the Knee at Donor Sites in Patients Undergoing Autologous Chondrocyte Implantation
• ACI autologous chondrocyte implantation
• the cartilage sub-region volume containing the main lesion whose shape is by nature more complex than the surgically created lesion, was measured via an automated segmentation approach using a 3D-active shape model. All sodium-MRI measurements were performed using a 15-channel sodium-only knee array coil and images with a resolution of 1.5x1.5x3 mm 3 were obtained in 25 min of scanning time.
• ROI region of interest
• sodium concentration maps were rescaled to the resolution of morphological proton images and overlaid with the corresponding morphological image.
• Cartilage sodium concentrations were calculated by using a calibration curve obtained for each scan from agarose phantoms having different sodium concentrations.
• GAG content in the index region was normalized to that of corresponding healthy regions of the same knee.
• a biopsy of the regenerated tissue was taken at the donor site, and tissue debris from the defect site was collected for histological and immunohistochemical analysis prior to the ACI graft implantation.
• Post-hoc pooled analysis of the sodium MRI data from both the donor and defect sites showed a statistically significant (p 0.01) increase in sodium signal intensity at Week 4.
• Compound 1 was rapidly distributed from the joint to the systemic circulation and no drug-related AEs or SAEs were reported during the course of this study.
• Example 3 A Two-part, Randomized, Placebo-controlled, Patient and Investigator Blinded, Study Investigating the Safety, Tolerability and Preliminary Efficacy of Intra- articular Compound 1 Injections in Regenerating the Articular Cartilage of the Knee in Patients With Articular Cartilage Lesions (Part A) and in Patients With Knee Osteoarthritis (Part B).
• Part A - Methods This is a randomised, double-blind, placebo (“PBO”)-controlled, proof- of-concept study in patients with a partial thickness cartilage lesion.
• 58 patients 43 [20 mg Compound 1]; 15 [PBO]), stratified by lesion type (condylar or patellar) were treated with 4 weekly i.a. injections.
• the primary endpoint was T2 relaxation time measurement as a marker of collagen fiber network
• cartilage lesion-volume was a secondary endpoint, both using 3 Tesla MRI.
• Assessments were performed at baseline, weeks (wks) 8, 16, 28 and 52 (the last in 23/58 patients).
• the overall safety profile was positive with treatment emergent mild/moderate local reactions (incidence of joint swelling [9.3% vs 0%] and arthralgia [7.0% vs 6.7%] for Compound 1 vs PBO) resolving spontaneously or with paracetamol/NSAIDs. No anti-drug antibodies were detected.
• Part B - Methods This is a randomised, double-blind, placebo (PBO)-controlled, proof- of-concept study in patients with mild to moderate osteoarthritis (Kellgren and Lawrence (K&L) grade 2-3 and joint space width 2-4 mm).
• 75 patients 25 [40 mg Compound 1], 25 [20 mg Compound 1]; 25 [PBO]
• the primary endpoint is safety and tolerability as well as the change in cartilage volume/thickness in the index region at Week 28 and 52 using 3 Tesla MRI.
• Cartilage quality will be assessed as secondary endpoint using T2 relaxation times as surrogate marker.
• KOOS pain and function are evaluated using the KOOS as secondary endpoints.
• Further exploratory endpoints comprise PK/PD assessments, biomarker, protein-expression and gene analyses. Assessments are performed at baseline, weeks 8, 16, 28 and 52. While lesion volume is determined from manually segmented images, the cartilage volume of 21 sub-regions spanning the entire knee is measured from 3D isotropic MR images employing an automated segmentation software (MR Chondral Health [MRCH], Siemens). The treatment effect is evaluated for the index region volume encompassing the lesion.
• MR Chondral Health [MRCH] MR Chondral Health
• Example 4 A 5-year, randomized, double-blind, placebo-controlled, multi-center study assessing the efficacy, safety, and tolerability of intra-articular regimens of Compound 1 versus placebo in patients with symptomatic knee osteoarthritis (ONWARDS)
• the regimens in this study will allow for comparisons of safety and efficacy data to: i) determine the appropriate dose (20 mg vs 40 mg) using the 20 mg Q4w x 3 every 6 months vs 40 mg Q4w x3 every 6 months; and ii) extrapolate for the optimal dosing regimen using 40 mg xl every 6 months, 40 mg Q4w x3 every 12 months and 40 mg Q4w x3 every 6 months.
• Compound 1 or placebo injections will be administered to keep the same number of total injections (Q4w x3 every 6 months in the Core Period and once every 6 months for 2 years in the Extension Period) in all cohorts. At the end of the Core Period, participants will enter the Extension Period.
• intervals of consecutive study treatment injections should be 4 +/- 1 weeks.
• the date of first study treatment in each cycle should be calculated based on the Week 0 (randomization visit) date, and it can be +4 weeks from the calculated date; e.g. Week 26 date should be determined as 26 weeks after the Week 0 visit date, and study treatment at Week 26 should be between 26 and 30 weeks after the Week 0 date.
• the study has been designed as participant- and investigator- blinded in order to reduce bias from both investigators and participants, so that a difference between the treated and control groups can be interpreted as an effect of study treatment.
• Study Population The study population will be comprised of male and female participants 40 to 75 years old with predominantly unilateral medial radiographic K-L grade 2-3 knee osteoarthritis and moderate to severe pain in the index knee (WOMAC Pain of 20-45 out of 50 on no medication or after pain medication washout) in the target knee during the screening period. A total of approximately 550 participants will be randomized. Participant selection is to be established by applying all eligibility criteria at Screening Visits 1 and 2. A relevant record (e.g., checklist) of the eligibility criteria must be stored with the source documentation at the study site. Participants who are randomized and fail to start treatment, e.g., participants randomized in error, will be considered as mis-randomized. Participants who have been randomized once cannot be screened or randomized again.
• the primary objective will be to assess the efficacy of each regimen of Compound 1 compared to placebo at Week 104 as measured by the mean change from baseline in cartilage thickness of the central medial tibiofemoral compartment (cMTFC) using quantitative magnetic resonance imaging (qMRI) of the target knee. It is anticipated that treatment with Compound 1 will result in an increase in cartilage thickness as compared to placebo.
• cMTFC central medial tibiofemoral compartment
• qMRI quantitative magnetic resonance imaging
• TFCs tibiofemoral compartments

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